Schedule -1
Statement of house and land required to be furnished pursuant to Section
4 of the Act and Rule 3
The Tax Officer,
Tax Office…………….
Dear Sir/Madam,
I/we have furnished the statement of the house and land as mentioned below for fiscal year…… pursuant to Section 4 of the House and Land Tax Act, 2019 (1962) and the House and Land Tax Rules, 2020 (1963). I/we request that
the house and land tax be assessed under the said Act and Rules. I/we shall pay the payable tax at the prescribed place within the time-limit as referred to in the Act from the date of receipt of the tax assessment order.
Particulars
1. Unit of house and land………
2. Boundaries of each house and land……..
3. Place tole where the house and land is situated and its block number:-
…….
4. Open space along with the house as well as the land covered with the
house:-
Length – feet breadth feet Bigaha or Ropani…….
5. Name of the road, if house and land is linked with the
road:-
6. (A) Cost price of house and land and date of purchase:-
7. (B) Cost price of house and proof thereof
8. If the house and land has been let on rent, the amount receivable therefore, date and portion of the house: – …………
9. Name, addresse of the partition shareholders of the house and land :-